Canada has recently been at the forefront of a global interest in liberalizing policies around Medical Assistance in Dying (MAID), or the legalization of euthanasia. What has made Canada’s approach unique, even compared to familiar northern European champions of the practice, such as Belgium and the Netherlands, is its availability to people not suffering from a terminal disease. 10,000 Canadians pursued this option in 2021, a figure representing around 3% of all Canadian deaths that year. In March of 2023, an expansion will take effect, allowing MAID for mental health conditions, and a proposal is under consideration to allow extension of the policy to “mature” minors.
Unsurprisingly, Canada’s system has been wildly controversial. On the one hand, it has elicited support from a variety of intellectual perspectives. Perhaps most comprehensively articulated from a philosophical perspective has been Richard Hanania’s essay “Canadian Euthanasia as Moral Progress” published on Substack on January 3rd of this year. Deeply and persuasively argued, however, Hanania’s thinking does operate from limited grounds: pragmatic, libertarian, and moral. Hanania first insists that the heat of the debate may be misplaced, given the relative rarity with which Canadians take advantage of the policy’s fringes—that is, its elaborations over and above the Belgian and Dutch models. He then turns to a defense of Canada’s liberalized MAID policies on grounds of its pushing back against the abridgment of individual freedom and embodied autonomy. Finally, he argues, the election of MAID might actually represent a noble and virtuous choice in the case of individuals choosing to unburden caregivers of responsibility and labor on their behalf.
Much digital ink has been spilled refuting Hanania (and those in his philosophical wake) on the pragmatic, libertarian, and finally moral points. To my mind, though, the more interesting critique of Hanania’s argument, and of MAID generally, is much more foundational. Consider the New York Times’ Ross Douthat, who I think correctly wrote on January 13th, that “you can see in Hanania’s own logic the potential for a much larger category of lives-not-worth-living: The degraded life, the depressed life, the painful life, the financially burdensome life.” In a column from December 3rd of 2022, Douthat expands on this position, noting that defenses like Hanania’s of MAID entail “[t]he idea that human rights encompass a right to self-destruction, the conceit that people in a state of terrible suffering and vulnerability are really ‘free’ to make a choice that ends all choices, the idea that a healing profession should include death in its battery of treatments — these are inherently destructive ideas. Left unchecked, they will forge a cruel brave new world, a dehumanizing final chapter for the liberal story.”
I share with Douthat a sense that addressing the issue through the parochial philosophical heuristics of pragmatism, libertarianism, or moralism—or even all three combined—essentially skirts around the issue. Where I differ from him, and quite profoundly at that, is in my openness to the idea that the right to self-destruction is, if, well, destructive, it is not, for that destructiveness, inherently rebarbative: my openness, in other words, to the idea that someone may correctly adjudge their life not worth living.
For me, such intellectual openness has almost become metonymic of or tautological with the health humanities in distinction from what may be residually known as the medical humanities. In my work and teaching, the health humanities departs from the medical humanities precisely in its skeptical relationship to health itself—not merely the asymmetrical distribution of health, of life chances, of vital flourishing, but the cultural valorization of the thing itself.
Oriented thus, I see in MAID and policies like it a novel openness to something other than the reflexive promotion and maximalization of life, a fairly powerful rejoinder to the biopolitical injunction to make live and let die. It is from this perspective, then, that I see defenses of MAID like Hanania’s as almost missing the point in their busy and diligent logic. I cannot help seeing his well wrought essay as an attempt to make assisted death productive, useful, even utile. What it might really represent—and this is why I think Douthat is right to appreciate its grandiose stakes—is an opting out of the accrual of value, a boredom with virtue and capacity and the rest of it. It is very much, then, “dehumanizing,” but all the more powerful, perhaps, in its rare disposal of the human and the latter’s compulsory dressage of dignity and usefulness.
As health humanists, we might do well to introduce this policy into our courses as a signal object lesson in our necessarily provisional field and improvisational methodology. But in doing so, I hope as educators we will have the stomach to discuss it in the full, awesome, and horrible scope of what it represents, in that way denying the impulse to launder it into the rationalizing language of liberal choice and the maximalization of subjectivity. It is, luckily, worse than that.
Bidwell, Kevin. “Orange and White Prescription Bottle on Table.” Photograph. Pexels. 21 January 2020.
Douthat, Ross. “What Euthanasia Has Done to Canada.” New York Times. 3 December 2022.
Douthat, Ross. “Will Euthanasia Be Secular or Sacred?” New York Times. 13 January 2023.
Hanania, Richard. “Canadian Euthanasia as Moral Progress.” Substack. 3 January 2023.